Background: Frontal bone osteomyelitis is considered to be rare but it may develop intracranial complications such as subperiosteal abscess that appears as a painful fluctuated forehead tumor (Pott's puffy tumor).
Methods: We reviewed retrospectively the clinical history of those patients showing frontal swelling tumour in our Neurosurgery and Infectious Diseases Departments between July 1994 and December 1997 and whose definitive diagnosis was cranial osteomyelitis.
Results: We reported five cases of patients who had been submitted to a neurosurgical operation between 9 months and 27 years ago. The main clinical features were intermittent painful frontal swelling episodes (with or without fever). These episodes were self-limited or limited after short trend of antibiotics. Imaging techniques were necessary for the diagnosis and especially in order to exclude intracranial complications (such as epidural abscess found in two patients). The ascertain diagnosis is made by debriding, histological studies and cultures from the material. Staphylococcus aureus was isolated in three of the patients, Haemophilus influenzae in one patient and Pseudomonas aeruginosa in the other one. All patients were treated with surgery and specific antibiotic therapy during twelve weeks minimum, being definitively cured.
Conclusions: It is not well know the etiopathogenic mechanism concerning this rare disease. We remark the importance of a prompt diagnosis because of the high frequency of intracranial complications as well as combined treatment: surgery and long term antibiotic therapy (not less than 8 weeks), is necessary to cure the disease.